MEDICAL OFFICER'S REPORT. very few years bring within conditions of decency and comfort myriads who now subsist under conditions which it is dreadful to contemplate. And as regards the accordability by the Legislature of such restrictive and compulsory powers as I have proposed, I House accomventure to submit two arguments:-first (as I have already modation of stated) that the objects which such legislation would tend to the Poor. compass are objects for which, in principle, the Legislature has already declared itself; and, secondly, that each of the powers which I name, as powers universally to be desired, is a power already legally exercised in some part or other of the country. In the latter point of view I would particularly beg leave to refer to the improvement-powers which are exercised in Liverpool under the local Act of 1864, and in Scotland under section 161 of the Scotch Police and Improvement Act; also to the powers which, in Glasgow under the local Police Act of 1862, and especially under its sections 384-8, in the city of Dublin under the 24th section of the Dublin Improvement Acts Amendment Act, 1841, and in the city of London under the City Sewers Act, 1851, are exercised against the crowding of tenement-houses. In concluding this section of my report, there are two more observations which I would venture to submit. In the first place, with regard to some of the worst conditions of dwelling in towns, it is scarcely possible that thorough reforms should be accomplished, unless large improvement-powers are in the hands of the local authorities, and are so exercised by them as gradually (by the requisite clearings of ground) to provide light and air for masses of population who now dwell in dark and unventilated places, or, where such clearings cannot be made, to purchase and destroy the poorer dwellings as "unfit for human habitation," and to provide equivalent new dwelling-space in the suburbs of the town: and I am glad to mention here two cases, where munificent beginnings of this sort are being made; Liverpool, where 100,000l. has been voted and is in course of being expended, for that one purpose; and Glasgow, which is now asking Parliament to sanction its spending within the next twenty years no less a sum than 1,250,000l. on improvement-purposes in great part similar. In the second place, I would advert to the uncompensated dislodgment and inconvenience which the laboring classes from time to time suffer through the destruction of parts of towns required for railways and other public purposes, in which parts they have hitherto had their homes. And I would suggest for consideration whether, when compulsory powers of purchase are being sought of Parliament for purposes of the above description, it would not be desirable that the local authority which is exercising improvement-powers on behalf of the laboring classes (and also perhaps individuals, interested as employers of many hands, or otherwise, in the well-doing of work-people) should have a locus standi for opposing the grant of such powers, except on condition that where many habitations are destroyed at least as many should be substituted for them. On this subject I beg leave to quote, as of the highest authority which special legal 13614. B MEDICAL OFFICER modation of the Poor, experience in such questions can give, an expression of opinion with which I have been favored by Mr. John Bullar:-" It has been objected that it is foreign from the objects of (for instance) a House accom- railway company to make them house speculators, and force them to lock up part of their capital in dwellings for the laboring classes; but this objection is altogether futile. Where it suits the interests of the shareholders, a railway company may add to their railway a canal, a dock, a harbour, a toll-bridge, a toll-road, or an hotel; and railway companies not only may, but in countless cases must, expend capital in making, and income in maintaining, for the landowners whose lands they touch, roads, sewers, drains, level crossings, bridges, cattle-creeps, watering-places, fences, and sometimes capital in providing farm buildings. The Lands and Railways Clauses Acts provide that ample compensation in money or works or both shall be made to landowners whose interests are interfered with, but do not make adequate provision for protecting the poor, whose means of living may be seriously lessened by the exercise of the powers of those Acts. There is nothing inconsistent with the course of legislation for public works that their undertakers should build as many houses as they pull down, just as they make a new piece of road where they block up the old road; and there is no reason why they should not sell their houses as soon as they think fit. The Lands Clauses Act requires them to sell within ten years after the completion of their works. If they lose by the sale the amount of the loss is the amount of the compensation unproductive to themselves which they make to the poor whom they dispossess; but with ordinary prudence they often may so arrange their building and selling operations as, if not to give them a profit, at least to make their loss a most insignificant part of their total outlay." Effect of sani ments. 2. A second large inquiry which my Lords undertook in 1865, tary improve but which could not within the year be completed, related to places in which, for some considerable number of years, proper works of drainage and water-supply have been established, or particular sanitary regulations been in force, and aimed at ascertaining, by local inquiries and examination of mortuary returns, what has been the effect of the works or regulations in improving health in each respective place. Dr. Buchanan is the inspector who has been employed on this inquiry. The places in which hitherto his investigations have been made-certain places, namely, in which the Public Health Act had been long adopted, and sanitary works under it had been constructed, are as follows:-Salisbury, Macclesfield, Croydon, Alnwick, Penrith, Morpeth, Ely, Ashby-de-la-Zouch, Carlisle, Leicester, Rugby, Stratford-on-Avon, Banbury, Warwick. His reports on these places have reached me too late to admit of their being included in the present volume. Both on this account, and also because the inquiry is being extended to other places, I think it best now to refrain from putting forward the conclusions which hitherto seem probable results of the inquiry. But I hope that in my next report I shall be able to present all the evidence which this inquiry aims at collecting, and at the same time to state conclusions which may be permanently valid (and I believe will be highly interesting) as to the practical fruit of our best-tested sanitary improvements. MEDICAL OFFICER'S REPORT. infected rags. 3. With a view to obtain, if possible, more exact knowledge Question of than was hitherto existing as to one particular alleged cause of injury from discase the alleged occasional conveyance, namely, of morbid contagia in the various stuffs which form the staple of the ragtrade, I, under their Lordships orders, instructed Dr. Bristowe to make detailed inquiry in quarters where affirmative evidence, if producible, would most readily be found, and especially in great paper-making establishments, as to any known facts which might seem to justify the suspicion referred to. Dr. Bristowe, after visiting many establishments in London of rag merchants and marine storedealers, and 86 paper mills, scattered in various counties of England, gave me the report which I append, No. 3. It is matter for congratulation that the results there recorded are almost entirely negative, and such, I think, as fully to establish that the rag-trade does not play any considerable part in the distribution of contagions of disease. More than this cannot, I apprehend, be maintained. When regard is had, on the one hand, to the sources of rag-supply, and on the other hand to the known properties of certain contagia, no one can suppose that paper-mills do not sometimes receive rags with infective material among them; and it would not have surprised me, if cases more or less authentic had been reported, where not only smallpox and other fevers, but also syphilitic inoculations, had, on particular occasions, been ascribed to the agency of foul rags. It will be observed, however, that, except in regard of smallpox, no such accusations came under the inspector's notice; and the instances wherein it was with some show of probability alleged that smallpox had been introduced by rags cannot be deemed to represent, in a vaccinated country, any serious amount of public danger. I have already elsewhere submitted my opinion (and must hereafter return to the point) that the Nuisances Removal law of the country requires to be strengthened by provisions, which may be summarily used, against such sorts of personal conduct as tend unnecessarily to spread dangerous infections of disease.* It seems to me that if provisions with that object are to exist, the offence of knowingly contributing to circulate rags which have been imbued with infectious material would almost of course fall within their scope. And, so far as present information extends, nothing further than that could be desired in the way of legislative precaution against the danger. * See last section of Letter in Appendix No. 9. See also last section of Report. MEDICAL OFFICER'S REPORT. Scientific researches. 4. It remains to be mentioned under the present head that, in aid of the more immediately practical objects of the department, my Lords, early in 1865, ordered certain scientific researches to be begun. Inquiries already made and reported on had set before the Legislature and the public much information, collected according to the current lights of medical science, with regard to the distribution and causes of all our most destructive diseases. The relations of typhoid fever and other diarrhoeal infections to the presence and decomposition of excremental impurity in air and water, the relation of the most fatal afflictions of artisan life to mere want of common ventilation, or of dust-withdrawing ventilation, in places of industry,-the relation, similarly, of miners' lung-diseases to the insufficient ventilation of mines, -the relation of our highest infantine death-rates to that neglect of infants, too often an almost murderous neglect, which follows the extensive industrial employment of women, whether in factories or in gang-agriculture, the relations of unconquered smallpox to ill-performed vaccination, and of this to demonstrable faults of local arrangement,-the relations of contagion to the spread of disease in different circumstances of life, and of overcrowding to the power of contagion,-these very important etiological relations had been studied, in their broadest bearings, in a large number and variety of local inspections throughout England, as well as in elaborate mortuary statistics; and the results of the study had been laid before Parliament, with other sanitary information, in the successive annual reports of the department. My Lords had now to determine what was to be done in the way of further like proceedings. It was submitted to them that by renewed inquiries, of exactly the same kind as heretofore, they might extend, but perhaps not importantly strengthen for practical purposes, the evidence already elicited on the great subjects which had been in hand; and that inquiries, tending chiefly to produce repetitions of evidence, would be but of secondary interest. Also it was submitted that, in the establishment of new principles for the prevention of disease, great steps of progress were now not likely to be made otherwise than with improved methods of aetiological observation; that scientific researches must first have created a far more intimate knowledge than is yet current as to the nature of the morbid processes which are to be prevented, and as to the physical and chemical conditions of their development ;—that such researches, on the scale and system which were to be desired, were not likely to be undertaken here by private investigators;— that, if their Lordships' inquiries were to continue to give fruit of national interest and importance, collateral work, aiming at such knowledge as I have just spoken of, must be combined with their Lordships' former line of inquiry, and serve hereafter in some sort as its pioneer.* * In relation to one very important disease, opinions like the above had, ten years previously, been pressed upon the attention of Government by the Medical Council, which the President of the then General Board of Health had called together to My Lords having instructed me to act in accordance with these views, investigations of the kind in question became in 1865 part of the work of the department. Hitherto they have had relation only to the chemical processes of disease, and here, under their Lordships' authority, I have had the advantage of Dr. Thudichum's assistance. At present I have only to name these investigations as of the category of work in progress. On future occasions I shall hope to particularise the proceedings, so far as their very technical subject-matter will permit, and of course from time to time to give their practical results. It may be, however, that these will not so much admit of popular appreciation as they will conduce to urgent professional requirements. The work is not of the kind which can promise either immediate returns, or such returns as are most popularly striking. But that medicine in its most practical aspects, whether preventive or curative, needs constant aid and guidance from purely scientific researches, is a fact on which it would be superfluous to insist. Of the convictions which in this respect are universal among enlightened persons, perhaps no stronger illustration could be cited than the urgency, almost the clamour, with which such researches were recently called for in relation to the steppe-murrain now in England, and the scale on which the Royal Cattle-Plague Commission ordered them. Also in another point of view I may refer to those researches for an illustration. Undertaken as they were in the medical interests of horned cattle, they yet elucidated some processes of disease in a way which is of interest to human pathology, and, through it, to the preventive medicine of mankind.* B. Occasional Proceedings. MEDICAL OFFICER'S REPORT. Besides inquiries systematically contributed as aforesaid to Occasional elucidate the common sanitary state and circumstances of the Proceedings. country, miscellaneous inquiries, which of course have tended to increase knowledge in the same direction, were made on many particular occasions, and generally at the instigation of local applicants, either with reference to actual excesses of disease, or with reference to conditions of filth from which such excesses might result. On occasions of the one sort or the other, my Lords, during 1865, ordered that inspectors should visit the following places:- Greenock and Bristol, where in both instances typhus was epidemic, and the local authorities requested my Lords to assist them by inquiry and advice; Maidenhead, where there advise him on the then prevailing epidemic of Asiatic Cholera. Ses Report of Medical Council, p. 8, and Report of the Council's Committee for Scientific Inquiries, pp. 65-6, among papers of General Board of Health laid before Parliament with reference to the Cholera-Epidemic of 1853-4. But cholera is only one of innumerable illustrations which might be adduced of our present practical stand-still for want of deeper scientific insight. *I refer particularly to the researches of Dr. Sanderson (reported in the Appendix to the Third Report of the Royal Cattle Plague Commission) on the propagability and incubation of cattle-plague, and on the physical state of its contagium. |